A 25-year-old woman presents with left ear pain for 2 days after swimming. You see a very edematous external auditory canal and tenderness of the pinna in an otherwise well-appearing patient. You only have partial visualization of the tympanic membrane. What are the most appropriate next steps in management?
- Prescribe topical antibiotics and provide administration education
- Remove this patient’s cerumen with a curette under direct visualization and prescribe ofloxacin drops.
- Prescribe ciprofloxacin/dexamethasone in combination with topical antibiotics
- Prescribe topicalpolymyxin B/neomycin/hydrocortisone
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Answer: B. You diagnose the patient with AOE. You carefully remove cerumen with a curette and note on your otoscopic exam that it is still difficult to see the entire tympanic membrane. You choose to avoid ototoxic antibiotics and prescribe ofloxacin drops. The patient is discharged and recommended to follow-up with primary care.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
